Newbie - ThinnerTimes

Tawanda · 12-20-2005, 10:35 AM

Hi Friends..I just wanted to let you know that I have been reading your posts for several weeks now and just decided to register. You all are one awesome group of people and I have learned so much just from reading the posts. Thank you so much for being so informative and supportive!

I am trying to get final approval from insurance today. This pre-approval process through the insurance company has been going on for four weeks! Ack! I am pretty much a stressball now, tired of calling every day and getting the run-around. Considering I have pre-op scheduled for Thursday and surgery for the 28th, I guess they had better hurry, huh?

Can any of you tell me if there is some legal criteria that says an insurance company HAS to give you an answer within 30 days? I'm thinking of seeing an attorney because I feel they are stalling. If they wait until after January 1st, a whole new deductible year starts and that means more out of pocket money for me!

Dave · 12-20-2005, 12:02 PM

Welcome! I don't know how far the process you are but approval is usually early on. If so it is doubtful you will get surgery before the end of the year. What all have you had done to this point? There is the initial informational seminar with the doctor, psycological exam, blood work, x-rays, and other tests, then a final exam with the doctor. At least there were the steps I had to take. My paper work was submitted after the psyc. exam and luckily came back in a few days. Sorry to hear you aren't having the same luck.

feliciaespinoza · 12-20-2005, 12:30 PM

Hi Welcome..... well Dave seems to have sumed it up there are still alot of tests and stuff that need to be done its a long process how did you get all your appointments before tests were done maybe your insurance does it differentaly not sure if you would get surgery that quick but I could be wrong its a patience game and so far 4 weeks is not a long time and what I have been told insurance has up to 30 days to respond to the request....I have heard average is about 3 months total for all the tests and insurance approval but like I said every insurance and Docs could be different. Welcome to our little family and just be patient I am sure it will all come together dont stress it wont make the matter move any faster in fact if you piss off the wrong person could take longer and it will only give you a belly ache so just be patient. Just be prepared financially if its gonna be more its VERY worth the wait and the financial headache.

Dave.... Welcome also havent seen you post before, nice of you to respond with help.

Dave · 12-20-2005, 01:24 PM

Thanks Felicia! Since I'm now to the point of surgery (next week) I've learned enough to throw out some useful stuff now and then

Hopefully I'll be more helpful after surgery.

coptergirl · 12-20-2005, 01:29 PM

Welcome to the forum! Each individual insurance company has it's own policies as to their approval time and how long they can take, and contractually, those policies can vary per group that is insured. I wish you the best of luck, and look forward to getting to know you better...

Tawanda · 12-20-2005, 01:33 PM

Hi Dave and Felicia...thank you for the replies.

I did have all the "stuff" done. In October, I had a psych eval. and a visit with a physical therapist as well as my gp's referral and a cardiologist's report to the surgeon's office. My bloodwork was done quite some time ago and it showed I'm insulin resistant. The surgeon's office submitted the request with attachments (38 pages!) to my insurance company on November 22. All of this trying to get things done by the end of the year. This is why I think that the insurance company is stalling.

I know I it doesn't help to stress, but this whole process actually started for me three years ago when they found that I have heart valve damage due to PhenFen usage. The cardiologist threatened that if I didn't lose some major weight I would be looking at heart valve replacement in as little as 10 years.

I was scared to death to even consider GBS! So I tried some more dieting, Slim Fast, joined a gym, cabbage soup...all that jazz. All I did was gain MORE weight and put myself into a state of constant stress, which we all know leads to more comfort food binging and kicking yourself in the tush. What a vicious cycle!

Felicia, I have been watching your trials with the thyroid problem. Not to worry. My sis was diagnosed with thyroid cancer about three years ago and they removed the thyroid and gave her some radiation treatments. She is fine...cancer free, doing great. AND, she actually takes less synthroid than I do (I have hypothyroidism, too...

). I will pray that things work out for you, too.

Anyway, thanks for your well wishes and I'll try to relax...it's either that or catch a plane to go t.p. the insurance company building!

Jeanie · 12-20-2005, 02:06 PM

I'm pretty sure that each state has their own rules on how quickly they have to give you an answer. As far as I know (I do medical benefits for a living) they only have 30 days in the state of CA to give you an answer, but those 30 days can just be "working" days if they want to be jerks about it. If you are denied (which I hope your not) you have 30 days to file an appeal and then they have 30 calander days to answer you back. Your state might be different, but you should be able to call the member service # and ask them how long they have to give you an answer. You don't have to tell them what it's for or who you are. Good luck. I hope you get your answer soon! Keep us updated on your progress!

Tawanda · 12-21-2005, 08:41 AM

For all the welcomes and bits of advice. I've decided you guys/girls rock!

I went to a local support group last night and told them all about you and this forum. Everyone was so amazed that there is a place where people can actually get some support.

Thank you!